-
Alopecia
localized or general loss of hair
-
Carotenemia
Discoloration (yellow) of skin, most noticeable on palms & soles. From veggies (carrots & squash) & hypothyroidism
-
Cyanosis
Bluish-gray or purple discoloration caused by presence of excessive amts of reduced hemoglobin in capillaries
-
Hematoma
Extravasation of blood of sufficient size to cause visible swelling from trauma or bleeding disorders. (Bruise)
-
Hypopigmentation
Loss of pigmentation resulting in lighter patches than a normal skin color. Caused by chemical agents, nutritional factors, burns, inflammation, & infection
-
Jaundice
yellow or yellowish-brown discoloration of the skin, best observed in sclera, secondary to increased bilirubin in the blood. Caused by liver disease, RBC hemolysis, pancreatic cancer, common bile duct obstruction.
-
Tenting
Failure of skin returning to normal position immediately after gently pinching. From aging, dehydration, or cachexia
-
ABCDE rule for Melanoma
Examine skin lesions for Asymmetry, Border irregularity, Color change/ variation, Diameter of 6 mm or more, and Evolving in appearance
-
Wood's Lamp
Exam of skin w/ long-wave UV light causes specific substances to fluorescence.
-
Patch test
Used to determine whether pt is allergic to specific testing material. Small amt of potentially allergenic material applied, usually to skin on back
-
Impetigo
Hemolytic strept or staph associated with poor hygiene. CONTAGIOUS. Thick, honey-colored crust most common on face. TREAT WITH ABX
-
Furuncle
Deep infection around hair follicle associated w/ severe acne. Tender, pus-filled areas on face, back of neck, axillae, breasts, butt, thighs, & perineum. Extremely painful. TREAT W/ ABX
-
Carbuncle
Multiple interconnecting furuncles. Most common on nape of neck. Pustules
-
Cellulitis
inflammation of SQ tissues following break in skin. Can progress to gangrene. TREAT W/ ABX, pt on contact precautions
-
Herpes Simplex type 1 & 2
Oral and genital. Life-long viral infection that effects skin and mucus membranes when exacerbated by sunlight, trauma, menses, stress, & systemic infection. TRANSMITTED BY RESP DROPLETS.
-
Herpes Zoster (Shingles)
Increased with age. Potentially contagious. Resembles chickenpox. Activated from varicella-zoster virus.
-
Plantar Warts
Caused by HPV. Wart on bottom surface of foot, growing inward. Painful when pressure applied
-
Candidiasis
Caused by candida albicans. Presents in warm, moist areas causing yeast to become pathogenic.
-
Tinea Corporis
Ringworm. Ringlike, scaly appearance w/ well-defined margins
-
Tinea Cruris
Jock itch. Well-defined scaly plaque in groin area. Does not effect mucus membranes.
-
Tinea Pedis
Athlete's foot. Interdigit scaling & maceration
-
Tinea Unguirum (Onychomycosis)
Increased w/ age. Effects finger & toe nails creating scaly, brittle, thickened, broken/ crumbling nails w/ yellow discoloration
-
Bedbugs
Feeding, usually at night. Wheal transforming into persistent lesion. Severe itching. Teach about hygiene. Fumigate home.
-
Pediculosis (Lice)
Parasites that suck blood & leave eggs and waste on skin & hair. Leaves small red points & severe itching. Occurs around back to school time
-
Scabies
Mites that penetrate stratum corneum, deposits eggs. Transmission by direct physical contact, presence of burrows.
-
Ticks
Causes Lyme disease. Spreads ringlike rask 3-4 wks after bite. Looks like a bulls-eye causes flu-like symptoms
-
Drug Allergy
Any rash w/ abrupt onset. Treat w/ antihistamines & corticosteroids (Benadryl is most common)
-
Acne Vulgaris
Inflammatory disorder of sebaceous glands. More common in teens. Corticosteroids can cause flair
-
Nevi (moles)
Grouping of norm cells derived from melanocyte-like precursor cells. Hyperpigmented areas (flat, raised, or hair)
-
Psoriasis
Autoimmune chronic dermatitis causing silvery scaling plaques
-
Acrochordons (skin tags)
common after midlife. Small, skin-colored, soft papules. Caused by high cholesterol
-
Antibiotics
Used both topically & systemically. Common OTC= Neosporin, bacitracin, & polymyxin. Prescription= mupirocin, gentamicin, & erythromycin
-
Corticosteroids
Topical=inflammation & itching. Corticosteroids can alter manifestations so dx before admin.
-
Antihistamines
Treats uticaria, angioedema, & pruritis. Warn about sedative effects. Claritin, Zyrtec
-
Skin scraping
Done with scalpel blade for microscopic inspection and dx
-
Curettage
scooping and removal of tissue w/ instrument w/ a circular cutting edge. Tissue sent for biopsy
-
Punch biopsy
Obtains tissue sample for study or removal of small lesion. Punches deep into flesh & tissue and placed in preservation solution
-
CD4+
- Main receptor HIV binds to. Pt can be asymptomatic for 10-12 years while HIV levels remain low in blood.
- Norm values: 800-1200
-
Systole
Contraction of myocardium, resulting in ejection of blood from ventricles
-
Diastole
relaxation of myocardium, resulting in filling of ventricles
-
Cardiac Output (CO)
amt of blood pumped by each ventricle in 1 min
-
Preload
vol of blood in ventricles at end of diastole, before next contraction
-
Afterload
Peripheral resistance against which the left ventricle must pump.
-
Contractility
Can be increased by epi and norepi released by SNS. Increasing contractility raises the SV by increasing ventricular emptying
-
Baroreceptors
Located in aortic arch & carotid sinus. Sensitive to stretch or pressure in arteries. Stimulation inhibits SNS & influences PNS. Decreasing arterial pressure causes opposite
-
Chemoreceptors
located in aortic & carotid bodies. Capable o initiating change in HR & arterial pressure in response to increased arterial CO2 pressure (hypercapnia) & decreased arterial O2 pressure (hypoxia) & decreased plasma pH (acidosis)
-
Pulse Pressure
Difference between SBP & DBP. Normally about 1/3nof SBP. Increased= exercise or atherosclerosis. Decreased= HF or hypovolemia
-
Mean Arterial Pressure (MAP)
Avg pressure in arterial system that is felt by organs of body. Map>60. MAP=(SBP+2DBP)/3
-
Normal VS. BP, HR, RR, Temp
BP: 120/80, HR: 60-80, RR: 12-20, Temp: 97-99
-
JVD
jugular vein distention. Can be caused by R sided HF
-
Pulse grades
0=absent, 1+=weak, 2+=normal, 3+=bounding
-
Bruit
Turbulent flow sound in artery caused by obstruction or aneursym
-
Murmur
Turbulent sounds occurring between normal heart sounds caused by valve disorder or abn blood flow patterns.
-
Valve replacement
Mechanical clicking noise caused by a mechanical valve
-
Pericardial friction rub
High-pitched, scratchy sound heard during S1 &/or S2 at the apex. Heard best w/ pt sitting & leaning forward & at end of expiration. Caused by pericarditis
-
Angle of Louis
Raised notch where 2nd rib meets sternum
-
Central cyanosis
Bluish/ purplish tinge along center such as tongue, conjunctiva, inner mucosa of lips. Caused by inadequate O2 sat of arterial blood from pul or cardiac disorders
-
Peripheral Cyanosis
Bluish/ purplish tinge in extremities or nose & ears. Caused by decrease in blood flow due to HF, vasoconstriction, cold environment
-
Cardiac Markers
released into circulation as byproduct of myocardial cell injury or death
-
Troponin
myocardial muscle protein released into circulation after injury. Any rise is dx of myocardial injury. Troponin I=<0.5. Troponin T=<0.1
-
CKMB
enzymes released by heart. 6 hrs after onset of symptoms, peak in 18 hrs, & return to norm 24-36 hrs after MI
-
ECG/ EKG
records electrical cardiac activity from different views. Can detect: rhythm, abn condition, size of atria & ventricles, PM activity, heart position, Hx of MI, presence of injury
-
Stress Test
uses 3 min stages at set speeds & elevation of treadmill to get pt to target HR
-
Systolic Failure
Results from inability of heart to pump blood effectively. Caused by impaired contractile function, increased afterload, cardiomyopathy, & mechanical abnormalities. Decrease in EF
-
Diastolic Failure
Inability of ventricles to relax & fill during diastole. Decrease filling of ventricles results in decreased SV & CO. Characterized by high filling pressures & engorged veins in pulm & systemic vascular systems
-
Dilation
enlargement of heart chambers due to long term elevated pressure in heart chambers. Decreased CO
-
Hypertrophy
Increase in muscle mass & cardiac wall thickness in response to overwork & strain. Occurs slowly b/c it takes time for increased muscle tissue to develop.
-
Left-sided HF
Results from L ventricular dysfunction causing blood to back up into pulm veins manifesting into pulm congestion & edema
-
Signs and symptoms of Left-sided HF
Increased HR, Decreased PaO2, slight increase in PaCO2, crackles, pleural effusion, change in mental status, confusion, restlessness, dyspnea
-
Right-sided HF
causes back up of blood into venous circulation. Venous congestion results in JVD, hepatomegaly, splenomegaly, vascular congestion of GI & peripheral edema. Primary causes is L sided HF
-
Signs and symptoms of R-sided HF
Murmurs, JVD, Edema, weight gain, Increased HR, ascites, fatigue, anxiety, anorexia, N/V, RUQ pain
-
Drug therapy for HF
Diuretics to decrease venous return & amt of blood returned to LV during diastole. Vasodilators to decrease circulating vol by decreasing preload & increasing coronary artery circulation by vasodilation
-
Morphine
decrease preload & afterload & frequently used to treat ADHF & pulm edema. Dilates both pulm & systemic blood vessels to decrease pulm pressure & improve gas exchange
-
Inotropes
Increased myocardial contractility. Digitalis improves LV dysfunction & increased contractility & myocardial O2 consumption
-
Normal BP
SBP <120 & DBP<80
-
Pre-HTN
SBP 120-139 or DBP 80-89
-
HTN stage 1
SBP 140-159 or DBP 90-99
-
HTN stage 2
SBP (> or = to) 160 or DBP (> or = to) 100
-
Modifiable risk factors of HTN
Alcohol, cigarette smoking, DM, elevated lipids, excess dietary sodium, obesity, sedentary lifestyle, stress
-
Non-modifiable risk factors of HTN
Age, gender, FmHx, ethnicity, socioeconomic status
-
CAD
HTN effects endothelium resulting in stiffened arterial wall & a narrowed internal lumen
-
L ventricular hypertrophy
Sustained high BP increases cardiac workload & produces LV hypertrophy. It is initially an adaptive or compensatory mechanism but over a long period of time, the heart can no longer meet the demand & HF develops
-
HF
occurs when hearts compensatory adaptations are overwhelmed & the heart can no longer pump enough blood to meet body's needs
-
CV disease
Atherosclerosis is most common cause of cerebrovascular disease. Risk of stroke 4x higher
-
Peripheral vascular disease
Atherosclerosis in peripheral blood vessels caused by HTN that leads to PVD, aortic aneurysm, & aortic dissection
-
Nephrosclerosis
HTN causes end-stage renal disease, especially in African Americans. Narrowed lumen cuses ischemia. Intrarenal
-
Retinal damage
Indication of concurrent vessel damage in the heart, brain, & kidneys
-
DASH diet
diet that emphasizes fruits, veggies, fat-free or low-fat milk & milk products, whole grains, fish, poultry, beans, seeds, & nuts. Significantly lowers BP (AKA cardiac diet)
-
HTN meds 2 main actions
1. decrease vol of circulating blood. 2. decrease SVR (systemic vascular resistence)
-
Diuretic physiology
promote Na+, H2O excretion, decrease plasma vol, & vascular response to catecholamines
-
Adrenergic Inhibitors physiology
Diminishes SNS effects that increases BP
-
Direct Vasodilators physiology
Decreased BP by relaxing vascular smooth muscle & decreased SVR
-
Calcium Channel Blockers (CCB) physiology
Increased Na+ excretion & causes vasodilation by preventing the movement of extracellular Ca+ into cell. Causes decreased HR, contractility, & stroke volume
-
Angiotensin Inhibitors physiology
Reduce A-II mediated vasoconstriction & Na &H2o retention
-
CAD
soft deposits of fat that harden with age
-
Collateral Circulation
Arterial anastomoses that exist w/in the coronary circulation
-
CAD developmental stages
A. Damaged endothelium. B. Diagram of fatty streak & lipid core formation. C. Diagram of fibrous plaque. Raised plaque visible (yellow or white). D. Complicated lesion: thrombus is red, collagen is blue
-
Chronic Stable Angina
CP when demand for myocardial O2 exceeds the ability of the coronary arteries to supply the heart w/ O2, causing myocardial ischemia
-
Prinzmetal's Angina (unstable angina)
CP that occurs at rest, usually in response to spasm of a major coronary artery
-
Major treatment of angina
- A. antiplate (ASA)/ Anticoag, Antianginal (Nitro), ACE inhibitor/ ARB
- B. Beta-blocker
- C. Cigarette smoking, CCB
- D. Diet, DM
- E. Education, Exercise
- F. Flu shot
-
Rheumatic Heart Disease
Chronic condition resulting from rheumatic fever that is characterized by scarring & deformity of the heart valves
-
Stenosis
Constriction or narrowing of valve
-
Regurgitation
incomplete closure of valve leaflets resulting in backward flow of blood
-
Mitral Valve Prolapse
Abnormality of mitral valve leaflets & the papillary muscles or chordae that allows leaflets to prolapse or buckle, back into the L atrium during systole
-
Aortic regurgitation
constituted as life-threatening emergency
-
Asthma
Persistent but variable inflammation of the airways. Caused by exposure to allergens or irritants initiates the inflammatory cascade
-
COPD
not fully reversible airflow limitation during forced exhalation caused by loss of elastic recoil & airflow obstruction
-
Various disease processes that occur during COPD
- 1. airway limitation
- 2. gas exchange abnormalities
- 3. Air trapping
- 4. Mucus hypersecretion
- 5. Severe disease pulm HTN
- 6. Systemic features
-
Asthma manifestations
onset <40, presence of allergies, intermittent symptoms, dyspnea absent except in exacerbations, stable disease coarse.
-
COPD manifestations
onset 40-50, long history of smoking, infrequent allergies, symptoms are slowly progressive or persistent, dyspnea during exercise, disease coarse gets progressively worse.
-
Normal ABGs for COPD
Often normal-low pH & PaO2; normal-high PaCO2 w/ high HCO3 (comp resp acid)
-
Total lung capacity
Max vol of air lungs can contain. norm=6.0L
-
Tidal volume
vol of air inhaled & exhaled w/ each breath. Only a small portion of TLC. Norm=0.5L
-
Residual Volume
Amt of air remaining in lungs after forced expiration. Norm=1.5L
-
Well controlled asthma
- Symptoms </= 2 days a week
- Nighttime awakenings </= twice a month
- No interference/ norm activity
- SABA use </= 2 days a week
- FEV, or peak flow >80%
-
Not well controlled asthma
- Symptoms >2 days a week
- Nighttime awakenings 1-3/ wk
- Some limitations during norm activity
- SABA use > 2days/wk
- FEV, or peak flow 60-80%
-
Very poorly controlled asthma
- Symptoms throughout day
- Nighttime awakenings>/= 4/wk
- Extremely limited normal activity
- SABA use several times per day
- FEV, or peak flow <60%
-
Flutter valve
Airway clearance device that causes airway fluttering which loosens mucus
-
Vest
connected to pulse-generator thru hoses. Generator delivers air which vibrates the chest, dislodging mucus from airways
-
Manual percussion
vibrate hand on chest wall during slow expiration which facilitates movement of secretions to larger airways
-
SABA
short acting beta2 adrenergics. Inhaled is most effective for relieving acute bronchospasm
-
MDI
Metered dose inhaler. Small hand-held, pressurized device that delivers a metered dose of drug w/ each activation
|
|